Engaged in March, Murray quickly sketched out her princess wedding: First, gastric bypass surgery in Mexico, where it's cheap. A walk down the aisle at half her weight in the gown of her dreams. A romantic honeymoon in Italy.

'She was everything to me,' Jason Sommerfeld says of his late fiancée, Annie Murray.

But she would only make it to Mexico.

Eight days after surgery there, Annie Murray was dead. She was 21.

"She was everything to me," her fiancé, Jason Sommerfeld, says.

Sommerfeld blames the Mexican doctor and the medical care for her death. He wants others to learn from Murray's story.

It is a cautionary tale of immeasurable regret and guilt about what was overlooked before and after the surgery.

Murray was one of the 180,000 people who are expected to travel abroad this year to chase after bargain-basement prices for tummy tucks, face-lifts and dental work, procedures that would cost drastically more in the United States. Mexico alone draws about 40,000 people a year from the U.S., according to Josef Woodman, who wrote Patients Beyond Borders.

"People buy into a fantasy," says Dr. Fred Barr, past president of the Palm Beach County Plastic Surgery Society, who, as part of a national board, is participating in a consumer campaign to warn patients about the pitfalls of medical tourism.

There are those who return home happy. But there have been widely reported incidents of others who have faced serious complications from infections, scarring, sham procedures - all made even more difficult by lax international oversight and the typical distances that keep doctors and their patients far, far apart.

Surprise road trip ends in Florida

Raised in San Leandro, Calif., Murray was smart, always reading. She was also the youngest of three children, and she quickly learned to use her head to win any fights with her siblings.

"She had a razor-sharp tongue," her mother, Juanita Baladad, remembers with a chuckle.

Murray's biggest struggle was with her weight. It ran in the family, her mom says. At 41, Baladad is obese, too, and her two daughters also grew up heavy.

When Murray was 10, she was already over 200 pounds, and by 21 she was carrying 320 on her 5-foot-3 frame, exhausting her body every minute of the day.

Sommerfeld wanted his fiancée to lose weight. He had watched her gain 70 pounds during the 41/2 years they dated, and he was concerned about her health.

But for Murray, the weight also may have represented an emotional burden, a past she wanted to leave behind. She worked hard, sometimes two jobs at once, sometimes six-day workweeks with 10-hour shifts - her way of keeping at bay the poverty that had marked her childhood.

There had been other ways to escape. She wrote poetry, read children's fantasy books and, at least last year, took the surprise road trip.

She and Sommerfeld, living in California at the time, bought their first car. On a whim last fall, the two drove east to Chicago. They got there and decided to make the outing permanent. Sommerfeld picked Florida as their new home because it seemed like a nice place to live.

The pair had not planned much further than that. They slept in their 1996 Saturn for a few nights before they got a place to stay in Royal Palm Beach - a small, unkempt house with mismatched floor tiles in the kitchen and an old hot tub that Murray converted into a planter for squash and tomatoes.

And so began a new life. It was here that Murray planned her wedding and where she told Sommerfeld that on the day they exchanged their vows, she didn't want to look like the rest of her family.

"I think I'm the reason she hated being fat," Baladad says.

Web site lists doctor's credentials

Uninsured, Murray needed to find a way to pay for the surgery with the $24,000 annual salary she earned as an assistant manager at a Palm Beach Gardens sub shop. The answer was Mexico, where she had heard that prices were significantly cheaper than the $20,000 to $40,000 that gastric bypass surgery can cost in the U.S.

Clicking her way through the Internet, Murray found Dr. Alejandro Aguirre Wallace, a bariatric surgeon based out of Ensenada who charged about $11,000 for the procedure.

When Sommerfeld found out Murray wanted to go there, he was surprised, he says, but his fiancée insisted. He agreed to support her.

"In a way it was my impulsive decision, just as much as it was hers," Sommerfeld says.

It seemed like a good deal. Aguirre's Web site stated that he had been performing bariatric surgeries since 1988 and listed him as a member of the Gainesville-based American Society for Bariatric Surgery and the Mexican Society of Obesity Surgery.

When Sommerfeld's mother learned about the trip, she worried. A nurse in Michigan, she wondered about Murray's follow-up care.

So Shelley Sommerfeld called one of Murray's surgery contacts, a man whom they knew only as Ruben, to ask about the hospital's protocols. She wanted to know what would happen if there were complications, but Ruben simply told her there would be none.

She was not convinced.

"I begged Jason not to go," Shelley Sommerfeld says.

Checkup lasts 10 to 15 minutes

May 31 was an exhausting day for Murray and Sommerfeld. They spent hours flying to San Diego, then several more hours in a car headed across the Mexico border.

Somewhere along the drive, they stopped at a gas station to meet Ruben so he could collect his portion of the surgery fees, 12 postdated checks at $252 apiece.

That afternoon they also met with Aguirre for the first time. After Murray went to the hospital for some lab work, she headed to his office for her consult.

Sommerfeld says Aguirre never asked her about her medical history. As far as her checkup, Aguirre just weighed her and lifted Murray's shirt to feel her stomach, Sommerfeld says.

All in all, the meeting lasted about 10 to 15 minutes, Sommerfeld says. Before leaving, the couple planted $3,300 in certified checks and cash on the doctor's desk.

The next day, a Friday, Murray had her surgery. Things seemed fine. But the hospital had difficulty in processing another payment - on three credit cards - for $4,800. Murray stayed in the hospital for about another day and a half. Aguirre stopped by only once to check on her at the hospital after the surgery, Sommerfeld says.

"He was kind of like a ghost," Sommerfeld adds.

On her last day at the hospital, nurses removed Murray's intravenous line and showed her how to empty a bag that was draining fluid from her abdomen.

Patient and fiancé stayed in Mexico for a few more days in an apartment owned by the doctor's office, leaving June 6. Murray had removed the drainage bag the day before, as she was told she could, but it was too soon to remove the staples. She told Aguirre that she was thinking of removing them herself once she was back home.

"It didn't seem to bother the doctor at all," Sommerfeld remembers.

Before leaving, Murray got a packet of paperwork describing her surgery and her lab results. The papers, some in Spanish, state that Murray is 30 years old - nine years off.

1 of every 200 patients can die

What Murray had done in Mexico in two days can take months in the U.S.

"There's a lot that has to happen before surgery," says Patricia Specian, program coordinator for Wellington Regional Medical Center's Surgical Weight Reduction Center.

First, patients don't pick their surgeons - it is the doctors who decide which patients can tolerate the operation. There is a complex screening process.

And there are always risks. A 2004 study conducted by The Journal of the American Medical Association found that about 1 out of every 200 patients can die from the surgery, which is why there are many tests done before the operation.

In Wellington's program, surgery candidates must have their lungs and heart checked by specialists, get lab work done and undergo a psychiatric evaluation to determine that they can make the lifelong commitment that the surgery demands.

Murray, on the other hand, spoke on the phone a few times with her Mexican contacts, including the doctor.

"It was never about counseling; it was just about whether she was coming down," Sommerfeld says.

While the Wellington center tells its patients that they cannot drive for a week after surgery, Murray was taking a cross-country flight back to Florida five days after hers. Aguirre's after-care guide says patients are free to go home after five to six days.

Less than 48 hours after her return, Sommerfeld found his fiancée lying on a sofa, struggling to breathe. He called 911.

Annie Murray died about 12:30 a.m. June 9. She weighed 317 pounds.

Sommerfeld says Murray died because she didn't get proper medical care, but Dr. Aguirre says it's unfair for Murray's family to blame him for her death.

After an autopsy was done, an investigator with the Palm Beach County Medical Examiner's Office talked to Sommerfeld and his mother about Murray's case. Shelley Sommerfeld says the investigator said the office was looking into many possible causes of death. Maybe it was an infection. Or a blood clot in her lungs. Maybe the stomach pouch was too small or there was a leak.

Officials from the medical examiner's office said Murray's final autopsy results would not be available until after a doctor could finalize a cause of death. The office was waiting for lab results, which could take as long as two months.

The office declined to comment on the case until its investigation is completed.

In the meantime, Aguirre says his methods are proper.

He denies that he saw Murray only once after the surgery; he saw her two or three times a day while she recovered in the hospital for two nights after the surgery.

Regarding surgery, Aguirre discounts the possibility of a leak in Murray's stomach, saying she would have felt bad two or three days after the operation.

"When she left, everything was OK," he says. "I saw her the day she left in the apartment and was doing very well."

He also says it is not possible that Murray's stomach pouch was too small.

"That is the point of the surgery," he says.

Aguirre said Murray and her fiancé left earlier than he would have liked. He said most patients remain in Ensenada for a week. Murray left on the fifth day after the surgery.

"It wasn't my decision for them to leave; it was their decision," he says. "They wanted to leave because they didn't pay the whole bill."

Medical memberships in doubt

Meanwhile, Aguirre's Web site touts his achievements and memberships in this area of medicine. However, the American Society for Bariatric Surgery says he is not a member, as he claims, but is merely on a mailing list. (Aguirre says he was a member in 1996.)

Also, Aguirre's name does not appear on the list of members of the Mexican Society of Obesity Surgery. When the society's president was contacted recently, he said he had not heard of the doctor.

Now Sommerfeld is the one making the plans - like whether to pack up and leave Florida, and which pictures of Murray to keep and which to give to her mother. And instead of a wedding, he planned his fiancée's memorial service.

It was held about a week after Murray's death, when her friends and family gathered at California's Lake Chabot to spread some of her ashes close to the neighborhood where she grew up.

Sommerfeld spoke during the gathering. Then one of Murray's nephews told the group that she was his favorite aunt.

Baladad, her mother, is trying to make sense of Murray's death. Murray's father, Michael Murray, died last year. Now this.

"I just know she wanted to lose weight and be a beautiful bride," she says.